No rules on cadaver usage

In the aftermath of the mysterious death of national rugby player Wasim Thajudeen and the controversy surrounding his body parts surfacing in a private medical college, SAITM, in Malabe it has come to light that Sri Lanka is lacking a proper code of conduct for handling human remains, for research purposes.

In other countries the subject of taking over dead bodies for education, research or transplant purposes are governed by a strict code of conduct. But, in Sri Lanka it is a grey area, governed by medical ethics and general guidelines by the Health Ministry, senior Judicial Medical Officers confirmed.

The Forum of Consultant Judicial Medical Officers have recently submitted a set of proposals to the Health Ministry Secretary Anura Jayawickerema, stressing the need to evolve a code of conduct to streamline this sector.

A member of the Forum who wished to remain anonymous due to the sensitivity of the subject said, “We don’t have a set of official guidelines on handling specimens and human parts for research or education purposes.”

He said, at present the JMOs who handle the human remains, follow the ethics of the medical profession. A dead body is defined as the property of the state and are treated with respect. Ethics is observed when taking over, preserving and dissecting an overall body or certain tissues or organs, he said.

The human remains are obtained for medical studies, through donations and of unclaimed bodies, such as beggars. In the case of donations, the next of kin has to give consent to the coroner. Thereafter, the bodies are released to the Judicial Medical Officers (JMO) who extract the necessary body parts or the entire body for dissection by medical students.

In unclaimed bodies the coroner can permit JMOs to release them as specimens. As regards bodies retained as court productions in murder cases, the Magistrate is vested with authority to release them as lab specimens to study gun shot wounds, etc.

President,Sri Lanka Medical Council, Prof.Carlo Fonseka said, in Sri Lanka, where people tend to give amply, the medical colleges do not run out of dead bodies.

He said, setting guidelines for doctors on handling human remains is not a specific function of the SLMC. “The general rule is, doctors must discharge their duties with a sense of responsibility, true to the profession.”

He said, however, there are broad guidelines issued by the Health Ministry.

Dr.Laksman Weerasena, a past President of the Medico Legal Society of Sri Lanka and the Independent Medical Practitioners’ Association of Sri Lanka said, in the distant past, as medical students, they used to anatomise criminals who were given death sentences.

“When I was a medical student I dissected a man convicted of murder in a famous case, where he killed his girlfriend. This man was killed by hanging.”

“The state owns the bodies of the hanged. I don’t know the ethics of it but such bodies were invariably sent to the medical colleges,” Dr.Weerasena said. This is not applicable any more, since death sentence is not imposed in Sri Lanka today.

There are three ways for medical students to get lab specimens for dissections,i.e. through donors, where one makes a declaration before death consenting to donate the body to a medical college. After the postmortem, with the consent of the relatives, the body is handed over to the JMO. Some have a brief funeral before doing so.

Second, where bodies of beggars and those unclaimed are handed over to the medical colleges through the JMO and the coroner, in the case of an unsuspected death.

Third, modern medical schools have their students dissect dummies, that are not dead people or real corpses. It is yet to be introduced in the Sri Lankan medical colleges.

Dr.Weerasena said, local medical colleges do not use bodies of deceased children for practical studies. “It goes beyond our ethics,” he said.

The bodies of people who had been killed or died under unique circumstances are preserved at the medico legal morgue for education purposes. Such bodies or body parts include gun shot injuries, burn injuries, etc. he said.

“When we do a postmortem, the JMO is permitted to retain any sample/ body part with the permission of the coroner, for teaching or research purposes. But whether they are allowed to transfer them to a private party is a question that needs to be answered,” a reputed Professor of Medicine said, in reference to the transfer of Thajudeen’s body parts to the private medical college.

The doctor, an expert in forensic medicine echoing Prof. Fonseka’s words said, Sri Lanka is full of charitable people, therefore we don’t run short of dead bodies for dissection. He added that at least once a week there is such donation.

The expert, who did not want to be named said, the bodies of the unclaimed were rare “That can be obtained with the permission of the coroner. But, usually they are disposed of in mass graves, at the expense of the government.”

The Colombo Medical College accommodates 200 students in a batch and the requirement for practical studies is 20 bodies for the six year course.

Another senior JMO said, the absence of a proper code of conduct in handling human remains is felt today more than ever.

Whatever body parts of value to students, such as Siamese twins, etc., permission has to be obtained from the next of kin. We must explain the exact purpose of preserving the body parts or organs. The bodies can be preserved and exhibited without divulging the origins or identities. Bodies washed ashore are also a source for lab specimen extraction but a Magistrate has to permit the release of such bodies to be used as specimen, the JMO explained.

He said, if the court determines that a body need not be kept in their custody any longer, it can be released for education or research purposes. In such instances, they are kept in a mortuary and entered in a register.

“It is not permitted to bring in human body samples scrupulously into colleges, which would be highly irregular,” the senior JMO said. He said, private medical colleges cannot store the body parts in museums without a court order or consent from the next of kin. “It could lead to many possibilities of wrongdoing,” he alleged.

Handling of human organs and body parts for transplant and education purposes are the same, and medical practitioners are bound by the same ethics. According to the ethics, doctors are also prevented from divulging the identity of the dead person. Likewise, permission is required for the disposal of the human remains retained for such purposes.

“Somewhere in the 1980s, a collection of skeletons used for study purposes and, later, rendered useless, was disposed of in this manner. We obtained a court order.

A religious ceremony covering all the faiths, Buddhist, Catholic, Hindu and Islam were performed before they were sent to the Borella cemetery to be incinerated,” the senior doctor said.

In the aftermath of the displacement of Thajudeen’s human remains, senior JMOs voiced that the Sri Lanka Medical Council (SLMC) should take the lead in the effort to seek government intervention and develop a comprehensive set of guidelines to streamline this sector. “This will be a good eye opener for all,” he stressed.

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